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Suture Closure versus Non-Closure of Subcutaneous Fat and Cosmetic Outcome after Cesarean Section: A Randomized Controlled Trial.

Husslein H, Gutschi M, Leipold H, Herbst C, Franz M, Worda C - PLoS ONE (2014)

Bottom Line: At two and six months no significant differences were found with respect to POSAS or VSS scores between groups.There was no difference in duration of surgery, SSI, seroma formation or wound disruption between groups.Suture closure of the subcutaneous fat at CS does not affect long-term cosmetic outcome. (Level I evidence).

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Klinikum Klagenfurt am Woerthersee, Feschnigstrasse 11, 9020 Klagenfurt, Austria; Department of Obstetrics and Gynecology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Wien, Austria.

ABSTRACT

Introduction: To investigate the effect of subcutaneous fat suture closure versus non-closure at cesarean section (CS) on long-term cosmetic outcome.

Material and methods: Women undergoing planned or unplanned CS were randomized to either subcutaneous fat suture closure or non-closure using a 1∶1 allocation algorithm. Participants and outcome assessors were blinded to group allocation. Scar evaluation was performed after two and six months. Primary outcome measures were Patient and Observer Scar Assessment Scale (POSAS) summary scores six months after surgery. Secondary outcome measures were Vancouver Scar Scale (VSS) summary scores, retraction of the scar below the level of the surrounding skin, duration of surgery, and development of hematoma, seroma, surgical site infection (SSI) or wound disruption. Data were analyzed according to the intention to treat principle.

Results: A total of 116 women were randomized and 91 participants, 47 in the closure and 44 in the non-closure group, completed the trial and were analyzed. There were no differences in patient morphometrics or surgery indications between groups. At two and six months no significant differences were found with respect to POSAS or VSS scores between groups. After two months significantly more women in the non-closure group described their scar as being retracted below the level of the skin (36% vs. 15%, p = 0.02) whereas no difference was observed at six months. There were significantly more hematomas in the non-closure (25%) compared to the closure group (4%) (p = 0.005). There was no difference in duration of surgery, SSI, seroma formation or wound disruption between groups.

Conclusions: Suture closure of the subcutaneous fat at CS does not affect long-term cosmetic outcome. (Level I evidence).

Trial registration: ClinicalTrials.gov NCT01542346.

No MeSH data available.


Related in: MedlinePlus

Flow diagram showing the progress through the trial.
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pone-0114730-g001: Flow diagram showing the progress through the trial.

Mentions: Overall 331 women were assessed for eligibility, of whom 37 declined participation and 14 did not meet inclusion criteria. Of the 280 who were able and willing to participate in this trial, 116 underwent CS delivery and thus were randomized. All women were of Caucasian origin. A total of 25 participants (21,6%), 11 in the closure and 14 in the non-closure group were lost to follow-up (Fig. 1). There was no difference regarding any demographic or obstetric characteristics or intra- or postoperative complications in patients lost to follow-up compared to patients who completed the trial. A total of 91 participants, 47 in the closure and 44 in the non-closure group were available for final analysis. Three participants did not receive the correct intervention but were included in final analysis according to the intention to treat principle (Fig. 1). Baseline demographic and obstetric characteristics are shown in Table 1. There was no difference between the two groups regarding parity, maternal age, body-mass-index (BMI), smoking or indication for CS.


Suture Closure versus Non-Closure of Subcutaneous Fat and Cosmetic Outcome after Cesarean Section: A Randomized Controlled Trial.

Husslein H, Gutschi M, Leipold H, Herbst C, Franz M, Worda C - PLoS ONE (2014)

Flow diagram showing the progress through the trial.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4262443&req=5

pone-0114730-g001: Flow diagram showing the progress through the trial.
Mentions: Overall 331 women were assessed for eligibility, of whom 37 declined participation and 14 did not meet inclusion criteria. Of the 280 who were able and willing to participate in this trial, 116 underwent CS delivery and thus were randomized. All women were of Caucasian origin. A total of 25 participants (21,6%), 11 in the closure and 14 in the non-closure group were lost to follow-up (Fig. 1). There was no difference regarding any demographic or obstetric characteristics or intra- or postoperative complications in patients lost to follow-up compared to patients who completed the trial. A total of 91 participants, 47 in the closure and 44 in the non-closure group were available for final analysis. Three participants did not receive the correct intervention but were included in final analysis according to the intention to treat principle (Fig. 1). Baseline demographic and obstetric characteristics are shown in Table 1. There was no difference between the two groups regarding parity, maternal age, body-mass-index (BMI), smoking or indication for CS.

Bottom Line: At two and six months no significant differences were found with respect to POSAS or VSS scores between groups.There was no difference in duration of surgery, SSI, seroma formation or wound disruption between groups.Suture closure of the subcutaneous fat at CS does not affect long-term cosmetic outcome. (Level I evidence).

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Klinikum Klagenfurt am Woerthersee, Feschnigstrasse 11, 9020 Klagenfurt, Austria; Department of Obstetrics and Gynecology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Wien, Austria.

ABSTRACT

Introduction: To investigate the effect of subcutaneous fat suture closure versus non-closure at cesarean section (CS) on long-term cosmetic outcome.

Material and methods: Women undergoing planned or unplanned CS were randomized to either subcutaneous fat suture closure or non-closure using a 1∶1 allocation algorithm. Participants and outcome assessors were blinded to group allocation. Scar evaluation was performed after two and six months. Primary outcome measures were Patient and Observer Scar Assessment Scale (POSAS) summary scores six months after surgery. Secondary outcome measures were Vancouver Scar Scale (VSS) summary scores, retraction of the scar below the level of the surrounding skin, duration of surgery, and development of hematoma, seroma, surgical site infection (SSI) or wound disruption. Data were analyzed according to the intention to treat principle.

Results: A total of 116 women were randomized and 91 participants, 47 in the closure and 44 in the non-closure group, completed the trial and were analyzed. There were no differences in patient morphometrics or surgery indications between groups. At two and six months no significant differences were found with respect to POSAS or VSS scores between groups. After two months significantly more women in the non-closure group described their scar as being retracted below the level of the skin (36% vs. 15%, p = 0.02) whereas no difference was observed at six months. There were significantly more hematomas in the non-closure (25%) compared to the closure group (4%) (p = 0.005). There was no difference in duration of surgery, SSI, seroma formation or wound disruption between groups.

Conclusions: Suture closure of the subcutaneous fat at CS does not affect long-term cosmetic outcome. (Level I evidence).

Trial registration: ClinicalTrials.gov NCT01542346.

No MeSH data available.


Related in: MedlinePlus